腹腔镜联合胆道镜治疗胆总管结石的临床体会

目的 探讨腹腔镜联合胆道镜治疗胆总管结石的手术方法,评价其手术安全性及Ⅰ期缝合胆总管的可行性.方法 对华北煤炭医学院附属医院2002年至2009年收治的51例胆总管结石患者,行腹腔镜胆道镜手术,切除胆囊,探查胆总管,切开取石,部分患者Ⅰ期缝合胆总管,部分患者留置T形管,Ⅱ期T管造影后去管.结果 51例中转开腹1例,Ⅰ期缝合胆总管26例;留置T形管24例,其中残余结石2例,均痊愈出院.结论 恰当的病例选择后,腹腔镜胆道镜联合治疗胆总管结石、Ⅰ期缝合胆总管不失为一种安全有效治疗胆总管结石的方法.     

腹腔镜联合内镜手术治疗胆总管结石132例临床分析

目的探讨腹腔镜联合内镜治疗胆总管结石的方法、适应证及临床价值。方法应用腹腔镜胆总管切开取石 胆道镜探查取石术(LCDE)治疗胆总管结石，联合内镜(十二指肠镜)处理胆总管结石和术后残石等并发症。结果鼻胆管引流49例。LCDE110，术后残石23例，6例未取净，内镜取净17例，胆漏5例，腹腔引流管持续少量胆漏经保守治疗4例治愈。化脓性胆管炎1例。中转开腹9例，无1例死亡。手术时间与开腹手术接近，术后住院时间明显缩短。部分病例随访6～12月以上未见远期并发症。结论腹腔镜联合内镜治疗胆总管结石，具有创伤小、有效、安全等优点；此术式可代替大部分开腹胆总管探查术，值得临床推广。     

腹腔镜胆总管探查术治疗胆总管结石58例临床分析

目的总结近三年来本院应用腹腔镜胆总管探查术治疗胆总管结石的经验。方法回顾分析2006年1月至．2008年8月应用腹腔镜胆总管探查术治疗胆总管结石58例的临床资料及随访结果。结果本组58例均成功实施LCBDE。手术时间1．1～3．0h（平均1．5h），术中出血约20～150ml（平均60m1），无一例中转剖腹，58例均术中一次取尽结石。术后恢复肛门排气12-72h（平均20h），住院时间4—7d，T管放置时间4～6周，腹腔引流管放置时间3～7d，3例胆瘘经腹腔引流5—7d自愈。均无切121感染以及胆道损伤等并发症。本组58例均得到随访，随访时间2～24个月，无胆道狭窄，无结石复发，无死亡病例。结论腹腔镜胆总管探查术治疗胆总管结石安全、有效，具有副作用少、创伤小、住院时间短等优点。     

腹腔镜联合胆道镜治疗胆总管结石53例治疗体会

目的：总结应用腹腔镜联合胆道镜治疗胆总管结石的体会。方法：回顾分析2003年1月至2009年5月成都市第五人民医院联合应用腹腔镜胆道镜治疗胆总管结石的临床资料。结果：经胆囊颈管取石成功21例,切开胆总管取石27例,其中胆总管I期缝合17例,T管引流31例,3例术后发生胆总管残余结石,经T管窦道胆道镜取石治愈,5例中转开腹。结论：选择合适病例,腹腔镜联合胆道镜治疗胆总管结石患者创伤小,效果好,且安全可靠。     

腹腔镜联合纤维胆道镜治疗胆总管结石

目的探讨腹腔镜联合纤维胆道镜治疗胆总管结石的治疗效果及手术方式。方法对34例胆总管结石患者在腹腔镜下行胆囊切除、胆总管切开、纤维胆道镜取石后行一期缝合或T管引流。结果手术时问平均135min，出血少，无手术并发症。14例胆总管一期缝合，20例T管引流。结论腹腔镜联合纤维胆道镜治疗胆总管结石创伤小，安全有效，术后恢复快。但应根据患者的实际情况选择行一期缝合或T管引流。     

腹腔镜联合胆道镜治疗胆总管结石临床分析

目的探讨腹腔镜联合胆道镜治疗胆总管结石的临床效果。方法选取76例胆总管结石患者为研究对象,随机分为两组．联合组46例行腹腔镜和胆道镜联合方案治疗,常规组30例行常规开腹手术治疗,对其临床效果进行对比分析。结果联合组手术时间较常规组长,差异有统计学意义（P〈0．05）,联合组手术出血量较常规组少,术后排气时间比常规组早,住院时间较常规组短,术后并发症较常规组少,差异有统计学意义（P均〈0．05）。结论腹腔镜联合胆道镜治疗胆总管结石临床效果显著、患者痛苦小、恢复快、预后良好、术后并发症少,能有效提高患者的生活质量,值得临床推广应用。     

腹腔镜联合胆道镜治疗胆总管结石的疗效观察

目的 研究腹腔镜联合胆道镜治疗胆总管结石的临床效果.方法 选取2009年6月～2020年4月我院收治的胆总管结石患者72例,采用随机数字表法分为对照组和观察组各36例.对照组行开腹手术,观察组行腹腔镜联合胆道镜手术.比较两组手术效果和术后并发症发生率.结果 观察组术中出血量、肛门排气时间及住院时间均明显低于对照组(P<...     

腹腔镜经胆囊管胆总管探查取石术治疗胆总管结石的临床研究

目的探讨腹腔镜经胆囊管胆总管探查取石术治疗胆总管结石的临床效果方法回顾性分析胆囊结石伴胆总管结石的62例患者的临床资料,根据手术方式的不同分为两组,腹腔镜经胆囊管胆总管探查取石术(LTCBDE组)28例、胆总管切开引流加T管引流术(LCHTD组)34例,对比两组手术的手术时间、中转开腹率、引流管留置时间、住院时间、住院费用、手术后并发症发生率。结果 LTCBDE组手术时间、引流管留置时间、住院天数、住院费用优于LCHTD组,差异有显著性(P<0.05);两组在中转开腹率及术后并发症比较,差异无显著性(P<0.05)。结论腹腔镜经胆囊管胆总管探查取石术是一种安全有效的术式,患者住院时间缩短,住院费用减少。     

腹腔镜联合胆道镜治疗胆总管结石的护理

目的:探讨腹腔镜联合胆道镜治疗胆总管结石的护理。方法:回顾分析72例胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜治疗胆总管结石的临床资料,总结手术前后的生理、心理特点,术后的相关观察及护理。结果:20例未放置T导管,其中有10例腹腔引流良好,52例放置T导管,均未发生胆汁漏。所有患者均无并发症发生,术后恢复良好。结论:加强手术前的心理护理及术后相关并发症的观察及护理,对提高疗效有重要的作用。     

腹腔镜联合胆道镜治疗胆总管结石临床效果观察

取135例腹腔镜胆总管结石病人为本次研究对象,回顾性分析其临床资料。本组患者均已治愈,其中手术成功者为102例,中转开腹33例。手术成功患者中经三孔法和四孔法完成手术者分别为13例、89例,其中6例经胆囊管,96例经胆总管前壁;33例为胆总管一期缝合,63例行T管引流。其中一过性胆漏为3例,均在3-5d后自行恢复,结石残留者为2例,均经手术后顺利取出。在胆总管结石患者治疗过程中,腹腔镜术式应结合个体化方案,从医院技术水平和患者病情实况出发,确保治疗方案最佳。     

腹腔镜术中经胆囊管胆道镜取石的方法

目的探讨腹腔镜手术中应用胆道镜经胆囊管途径进行胆总管检查取石的方法及临床价值.方法回顾性分析本院1999年10月～2004年12月间,在腹腔镜手术中成功实施经胆囊管途径的胆道镜检查、取石病人48例.结果腹腔镜手术中经胆囊管途径的胆道镜检查取石48例病人均获成功,其中30例直接经胆囊管插入胆道镜,18例经胆道探子轻柔持续扩张胆囊管后,胆道镜经胆囊管顺利插入胆总管,直接取出结石45例(93.75%),共94枚(92.15%)结石,3例(6.25%)病人有8枚(7.85%)结石直径大于0.6～1.0cm,经过应用等离子体中击波碎石器碎石后取出.结论腹腔镜手术中应用经胆囊管途径检查、取出胆总管内结石的方法,安全可行,较之腹腔镜术中胆总管切开取石的方法,创伤更小,是胆道结石病微创外科治疗技术的又一进步和提高.     

硬质胆道镜在腹腔镜胆总管探查取石中的应用

目的 探讨硬质胆道镜在腹腔镜胆总管探查取石术中的应用价值及技术要点。方法 分析2010年6月以来腹腔镜胆总管探查治疗胆总管结石40例。结果 全部患者操作成功,结石取净率80.0%。,手术并发症4例,其中胆漏3例,穿刺孔感染1例,并发症发生率10%。结论 硬质胆道镜联合腹腔镜治疗胆总管结石安全、有效,方便、快捷,尤其适用于较大难取性结石。     

十二指肠镜、腹腔镜联合序贯治疗胆囊合并胆总管结石204例

目的:探讨十二指肠镜、腹腔镜联合序贯治疗胆囊合并胆总管结石的疗效。方法:总结用十二指肠镜处理、取出胆总管结石后,用腹腔镜切除胆囊治疗胆囊合并胆总管结石病例的经验。结果:204例病例的治疗均获得成功。结论:胆囊合并胆总管结石的病例,通过十二指肠镜取出胆总管结石后,可以行单纯胆囊切除术,从而避免了开腹或腹腔镜胆总管探查等操作较复杂、创伤较大的手术方式。     

Preoperative determinants of common bile duct stones during laparoscopic cholecystectomy

Introduction: The aim of this study is to determine whether there are any clinical or biochemical predictors of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy. Methods: A prospective database of nearly 1000 laparoscopic cholecystectomies performed under the care of a single surgeon with a standardised technique between 1999 and 2006, was analysed. Clinical presentation, ultrasound and immediate preoperative biochemical results as well as the operative cholangiogram findings were reviewed. Routine cholangiography was attempted in most patients and the primary outcome variable was the detection of bile duct stones. The data was analysed using chi‐squared test for categorical variables. The significant variables on univariate analysis were further characterised to identify the independent predictors of bile duct stones using a logistic regression model (significance p < 0.05). Results: A total of 757 of 988 patients (77%) underwent cholangiography. Male‐to‐female ratio was 1 : 3 with a median age of 54 years (range: 17–93). Ten per cent of patients had bile duct stones identified on cholangiography. On univariate analysis, jaundice (p = 0.019), cholangitis (p < 0.001), alanine transaminase > 100 (p = 0.024), alkaline phosphatase (ALP) > 350 (p < 0.001) and CBD > 10 mm (p = 0.01) were significant markers for predicting bile duct stones. Bilirubin > 30 (×2 normal) was found not to be significant (p = 0.145). On a logistic regression model, ALP > 350 and/or cholangitis were found to be independent predictive factors of CBD stones (odds ratio 6.1). Conclusions: If a policy of routine intra‐operative cholangiography is not adopted, a history of cholangitis or a raised ALP immediately preoperatively should lead to a high suspicion of CBD stones.     

Combined endoscopic and laparoscopic treatment of common bile duct stones

In a consecutive series of 228 patients reterred to Kalundborg Sygehus, Surgical Department, for treatment of gall bladder disease, 17 patients had common bile duct (CBD) stones. Nine were found pre-operatively and treated with endoscopic retrograde cholangiography (ERC), papillotomy and stone extraction. In two cases, however, the ERC procedure failed and the patients were treated successfully using laparoscopic therapy. Six CBD stones were found during laparoscopic surgery. Four of these patients were treated with laparoscopic stone extraction. In two patients laparoscopic stone extraction was not possible and they were treated post-operatively with ERC and stone extraction. Two CBD stones were discovered after laparoscopic cholecystectomy. One was treated with ERC and stone extraction, the other with open surgery. By combining endoscopic and laparoscopic procedures, it is possible in most cases to avoid open surgery for the treatment of CBD stones.     

腹腔镜胆囊切除术后胆总管残留结石的防治

目的探讨腹腔镜胆囊切除术(laparoscopic choleystectomy,LC)后胆总管残留结石的原因和预防措施。方法我院2003年1月至2008年6月无胆道镜前发生LC术后胆总管残留结石11例,2008年7月至2011年1月有胆道镜后可疑合并胆总管结石10例,比较分析二者术前诊断及术中处理方法。结果无胆道镜前发生的11例经LC并胆总管切开取石术或开腹胆总管探查取石治愈;有胆道镜后10例经过胆道镜检查和选择性胆道造影处理,术后均未发生胆总管残石。结论 LC术后胆总管残留结石应重视,术前积极检查,术中正确处理可以预防。     

腹腔镜胆道手术用于胆总管结石治疗的临床研究

目的比较腹腔镜胆囊切除+胆总管切开探查取石术和传统开腹胆囊切除+胆总管切开探查取石术的临床效果。方法 75例胆囊结石合并胆总管结石患者分两组,腹腔镜组31例行腹腔镜胆囊切除+胆总管切开取石术;44例传统开腹胆囊切除+胆总管切开取石术。统计手术时间,术后胃肠功能恢复时间,术后住院时间及并发症。结果与开腹组比较,腹腔镜组患者住院时间短[(5.3±1.2)d vs.(7.0±2.5)d],术中出血少[(54±16.7)ml vs.(62±12.3)ml],手术时间短[(58±11.3)min vs.(65±9.67)min],通气时间短[(2.3±0.6)d vs.(2.7±0.4)d]。两组并发症和结石清除率无明显差异。结论腹腔镜胆总管切开取石术完全能达到传统开腹胆道切开取石术的效果,并具有创伤小,痛苦少,恢复快的优点。     

Transcystic duct treatment of common bile duct stones

Successful removal of 2 retained common bile duct stones following cholecystostomy is described. With the use of the steerable catheter and the wire basket, one stone was crushed and the second was extracted in retrograde fashion through the cystic duct and gallbladder.     

Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era: a systematic review

Background: There is still no consensus on the ideal management of common bile duct (CBD) stones. This article aims to review the management of concomitant gallbladder stones and CBD stones in the laparoscopic era. Method: A PubMed database search was performed to identify MEDLINE articles from 1986 to 2010 using the key terms “common bile duct stones,”“cholecystectomy,”“bile duct exploration,”“ERCP” (endoscopic retrograde cholangiography), and “endoscopic sphincterotomy.” Results: There were five randomized comparative trials (RCT) comparing sequential preoperative ERCP and laparoscopic cholecystectomy (LC) to laparoscopic common bile duct exploration (LCBDE). Two RCTs showed similar stone clearance rates and shorter hospital stays in the LCBDE group, while three RCTs showed similar stone clearance rates and hospital stays in sequential preoperative ERCP, LC and LCBDE groups. There were two RCTs comparing LCBDE to sequential LC and postoperative ERCP. One showed similar stone clearance rate and shorter hospital stay in LCBDE group, while the other showed similar stone clearance rate and hospital stay. There were three RCTs comparing sequential preoperative ERCP and LC against LC with intraoperative ERCP. All three studies showed similar stone clearance rates and shorter hospital stays in the intraoperative ERCP group. There was only one RCT comparing sequential preoperative ERCP and LC against sequential LC and postoperative ERCP. This showed a similar stone clearance rate and shorter hospital stay in the postoperative ERCP group. Conclusion: Different management approaches of concomitant gallbladder stones and CBD stones were equivalent in efficacy. However, one‐stage management had the advantage of providing a shorter hospital stay.     

腹腔镜联合胆道镜胆总管探查术

目的 :探讨腹腔镜胆总管探查术在临床的应用价值。方法 :运用腹腔镜结合胆道镜的微创方法治疗 3 1例胆总管结石 ,同期行开腹胆总管探查术 48例。结果 :腹腔镜组手术与开腹组手术均获成功 ,腹腔镜组除 1例因结石嵌顿采用小切口取出结石外 ,其余病例均在镜下完成。两组均无残留结石及严重并发症。两组手术时间相近 ,但腹腔镜组住院时间明显缩短。结论 :腹腔镜联合胆道镜治疗胆总管结石优于传统手术 ,在具备较高腹腔镜技术水平的条件下是安全可行的 ,可代替大部分开腹胆总管探查术